1099R Box 5 not deducted from taxable amount

I have a 1099R where box 1 and 2a are the same number.  There is also an entry in box 5 for the insurance cost I had.  Shouldn't box 5 be deducted from box 1 to get box 2a?  If not, I am itemizing my medical costs, should I include the amount in box 5 as an insurance premium?

 

a little detail...  Box 1 is equal to the amount I actually got paid each month plus the amount shown in Box 5